左束支起搏患者导线稳定性的观察

Lead stability in patients with permanent left bundle branch pacing

目的本研究旨在评价永久性左束支起搏患者导线的中长期稳定性。方法研究入选了2017年11月至2019年6月在南京医科大学第一附属医院心内科五病区成功进行左束支起搏的患者。术后1、3、6个月,1年,之后每年1次定期随访患者的起搏参数,包括R波感知、阈值、阻抗;记录不同电压下的单极和双极起搏心电图。对起搏参数或起搏心电图有明显变化者,行超声心动图或双源CT以明确导线头端的位置有无改变。结果共220例患者成功完成左束支起搏,男124例,平均年龄(68.7±11.9)岁。具有基线和至少1次随访资料的患者169例,平均随访(10.5±5.2)个月,起搏参数均无明显改变[术后6个月:起搏阈值(0.7±0.2)V对(0.5±0.1)V,P>0.05;R波振幅(18.1±7.3)mV对(15.9±7.4)mV,P>0.05]。未见起搏阈值>1 V的患者。术中导线穿入左心室腔者3例,术后未发现穿入左心室病例。术中导线脱位4例,其中2例成功重置左束支起搏导线。术后导线脱位至右心房1例,后重置导线至右心室心尖部。术后导线微移位7例,起搏心电图出现改变,但导线参数未见明显变化,经影像学证实导线仍位于室间隔内,其中6例患者于术后1周内出现,7例均未做特殊处理,经随访起搏感知功能均正常。结论左束支起搏导线的中长期参数稳定可靠,但需密切关注起搏心电图的变化及导线微移位现象。

Objective The aim of our study was to report the mid-long term lead performance in patients with permanent left bundle branch(LBB)pacing.Methods We enrolled the patients with successful LBB pacing from November 2017 to June 2019 in the Fifth Ward of Department of Cardiology in the First Affiliated Hospital of Nanjing Medical University.Programmed parameters,including R-wave amplitude,pacing threshold,and impedance,were analyzed regularly.Electrocardiograms(ECG)under lead tip and bipolar pacing were routinely recorded.For the patients with changed pacing parameters or ECG morphologies,echocardiogram or cardiac dual-source CT was performed to determine the position of the lead tip.Results Totally LBB pacing was successfully performed in 220 patients with 124 males,and a mean age of(68.7±11.9)years.One hundred and sixty-nine patients with baseline and at least one follow-up records were included.Pacing parameters of LBBpacing were unchanged during a mean follow-up of(10.5±5.2)months.There was not significant difference of the mean pacing threshold[(0.7±0.2)V vs.(0.5±0.1)V,P>0.05]and R-wave amplitude[(18.1±7.3)mV vs.(15.9±7.4)mV,P>0.05]at 6-month follow-up.No patient of elevated pacing threshold over 1 V was found.Lead protrusion into left ventricular cavity occurred in 3 patients during procedure,and none after the implantation.Four patients had lead dislodgement during procedure and 2 patients were re-implanted LBB pacing leads successfully.One patient had lead dislodgement to the right atrium after the implantation and the pacing lead was positioned at right ventricular apex at one-month follow-up.Lead micro-displacement was observed in 7 patients with changed pacing ECGs but unchanged pacing parameters.Imaging tests confirmed that the pacing leads were still within the ventricular septum.Most of the patients(6/7)were found with lead micro-displacement in one week after the procedure.No lead revision was needed in all 7 patients due to the normal programmed tests.Conclusion LBB pacing was safe with stable pacing parameters during mid-long term follow-up.Lead micro-displacement should be paid attention when pacing ECG changed but programmed parameters were normal.